Chapter 6
Somatic Symptom & Related
Disorders & Dissociative
Disorders
Somatic Symptom &
Related Disorders
 Soma – Meaning Body

Preoccupation with physical disorders

Excessive or maladaptive response to or
associated health concerns
Includes the following 5 disorders:

Somatic symptom disorder
Illness anxiety disorder
Psychological Factors affecting medical
condition
Conversion disorder
Factitious disorder




Somatic Symptom Disorder
Illness Anxiety Disorder
 Formerly called “hypochondriasis”

Physical symptoms are not presently
experienced or are mild

Severe anxiety about the possibility of
having a serious disease

Strong disease conviction

Medical reassurance does
not seem to help
Illness Anxiety Disorder
1% to 5%
 6.7% median rate of medical patients
 Causes


Cognitive perceptual distortions

Familial history of illness
 Treatment

Challenge illness-related misinterpretations

Provide more substantial and sensitive
reassurance

Stress management and coping strategies
Conversion Disorder
(Functional Neurological Symptom Disorder)

Physical malfunctioning

Lack physical or organic pathology

Malfunctioning often involves sensorymotor areas

Retain most normal functions,
but lack awareness

Freudian explanation

Emphasis on the role of past trauma

Not same as malingering (faking)
Factitious Disorders
Intentionally produced symptoms
 No obvious benefit
 Factitious disorder imposed on another’
known previously as Munchausen
syndrome by proxy
 Intentionally produced symptoms in
another person

Dissociative Disorders

Involve severe alterations or detachments

Affects identity, memory, or consciousness

Depersonalization – Distortion is perception of
one’s own reality

Derealization – Losing a sense of the external
world

Severe and frightening feelings of unreality and
detachment

Feelings dominate and interfere with life
functioning
Depersonalization-Derealization
Disorder
 Facts and Statistics

High comorbidity with anxiety and mood disorders

Onset is typically around age 16

Usually runs a lifelong chronic course
 Causes

Cognitive deficits in attention, short-term memory,
spatial reasoning

Such persons are easily distracted

May begin with no trigger or stress/trauma
 Treatment

Little is known
Dissociative Amnesia
 Dissociative Amnesia

Includes several forms of psychogenic
memory loss

Most common dissociative disorder

Generalized vs. localized or selective type
 Dissociative Fugue (sub-type of dissociative
amnesia)

Take off and find themselves in a new place

Unable to remember the past

Unable to remember how they arrived at new
location

Often assume a new identity
Dissociative Amnesia

Usually begin in adulthood

Show rapid onset and dissipation

Occur most often in females
 Causes

Little is known

Trauma and stress can serve as triggers
 Treatment

Most get better without treatment

Most remember what they have forgotten
Dissociative Identity Disorder
(DID)

Has at least 2 or more distinct identities
(personality states)

Identities display unique behaviors, voice, and
posture

Alters – Different identities or personalities

Host – The identity that keeps other identities
together
Can it be faked?

Hillside strangler case

Controversial diagnosis
Dissociative Identity Disorder
(DID)
Average number of identities is close to 15
(as many as 100)
 Ratio of females to males is high (9:1)
 Onset is almost always in childhood
 High comorbidity rates & lifelong, chronic
course
 Considered rare

Dissociative Identity Disorder
(DID)
 Causes

Histories of horrible, unspeakable, child abuse or
other trauma

Closely related to PTSD

Mechanism to escape from the impact of trauma
 Treatment

Focus is on reintegration of identities

Identify and neutralize cues/triggers that provoke
memories of trauma/dissociation